Managing Glaucoma: Concerns About Stopping Eye Medication

I want to stop my glaucoma medication?

Hello,
I have been informed by my doctor since April 19, 2003, that I have elevated intraocular pressure (IOP) (right eye 21, left eye 20), which may indicate glaucoma.
I started using medication (Timolol 2%).
After that, except for the first follow-up visit when my IOP was still high (right 26, left 24.5), my pressure has been well controlled.
However, after the visual field test in October 2003, the doctor noted that my IOP was low but the optic nerve condition was poor, so I began using a second medication (Brimonidine).
I have been regularly visiting the ophthalmology department every month to pick up my medication and check my IOP, and everything has been normal without any issues.
However, in the past six months, my eyes have been very dry.
Due to the long-term use of eye drops, on February 28, 2006, I expressed my desire to stop the medication to my doctor.
The doctor first discontinued Timolol and advised me to monitor my IOP closely after stopping the medication to avoid uncontrolled elevated IOP.

Therefore, I would like to ask the following questions:
1.
A year and a half ago, I also wanted to stop the medication, but the doctor told me that it would be more appropriate to stop if my IOP was below 12.
Why is it that this time, with an average IOP of only 14 or 15, the doctor allowed me to stop the medication? (Note: The hospital has not changed, but the doctor has.)

2.
Does long-term use of medication lead to dry eye syndrome?

3.
On March 4, 2006, I went to a nearby ophthalmology clinic (the one originally opened by my doctor) to check my IOP, informing them of my medication cessation.
The IOP was measured at (right 15, left 13), but they did not mention the need for frequent monitoring at the hospital.
How often should I check my IOP to be considered normal?

4.
The doctor informed me that I have a 60% to 70% cupping of the optic nerve, which is between moderate and severe.
What implications does this have for my vision? During the visual field test, I felt a shadow covering the area near the head of my left optic nerve.
Will this condition worsen over time?
I apologize for the lengthy message, and I appreciate your responses.
Thank you.

Ava, 20~29 year old female. Ask Date: 2006/03/05

Dr. Ke Meilan reply Ophthalmology

Hello, you may have low-tension glaucoma.
Some doctors believe that an intraocular pressure of 12 mmHg is safe, while others consider 14-15 mmHg to be safe.
The side effects of medications can include dry eyes, but this is not common with these two types of eye drops.
The management of intraocular pressure should be determined by the extent of visual field loss.
Proper control will slow down the progression of the disease.
Best wishes, Komeilan.

Reply Date: 2006/03/05

More Info

Managing glaucoma, especially when considering stopping eye medication, is a complex issue that requires careful evaluation of various factors, including intraocular pressure (IOP), optic nerve health, and individual patient circumstances. Here’s a detailed response to your questions based on the information provided.

1. Why was I allowed to stop medication with an average IOP of 14-15?
The decision to stop medication often depends on a combination of factors, including the stability of your IOP readings, the health of your optic nerve, and the overall assessment by your ophthalmologist. While your previous doctor suggested stopping medication only if IOP was below 12, the new doctor may have a different approach or may have assessed that your optic nerve health and visual fields are stable enough to allow for a trial off medication. It’s important to have open communication with your healthcare provider about their rationale for this decision.

2. Can long-term use of eye drops lead to dry eyes?
Yes, prolonged use of certain eye drops, especially those containing preservatives, can contribute to dry eye symptoms. Medications like beta-blockers (e.g., timolol) and prostaglandin analogs can sometimes cause ocular surface irritation, leading to dryness. If you are experiencing significant dryness, it may be beneficial to discuss this with your ophthalmologist, who may recommend preservative-free formulations or additional treatments for dry eye management.

3. How often should I monitor my IOP after stopping medication?
After stopping glaucoma medication, it is crucial to monitor your IOP closely to ensure it remains within a safe range. The frequency of monitoring can vary based on individual circumstances, but generally, it is advisable to check IOP every few weeks initially after stopping medication. Once stability is confirmed over a few months, the frequency can be reduced to every 1-3 months. Your ophthalmologist will provide specific recommendations based on your situation.

4. What does a 60%-70% optic nerve cupping mean for my vision?
Optic nerve cupping of 60%-70% indicates significant damage to the optic nerve, which can be associated with glaucoma. This level of cupping suggests that there has been a loss of nerve fibers, which can lead to visual field loss. The presence of a "shadow" in your visual field, particularly near the center, is concerning and may indicate that your glaucoma is progressing. It is essential to have regular visual field tests to monitor any changes. If your optic nerve continues to deteriorate, it could lead to further vision loss.

In summary, managing glaucoma involves a delicate balance of monitoring and treatment. Stopping medication should be done cautiously, with regular follow-ups to assess IOP and optic nerve health. If you experience any changes in vision or increased symptoms of dry eyes, it is crucial to consult your ophthalmologist promptly. They can provide tailored advice and adjust your treatment plan as necessary to ensure the best possible outcomes for your eye health.

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